The role of free-tissue transfer for head and neck burn reconstruction

Background: The reconstruction of head and neck burns is challenging, traditionally involving skin grafting and local flaps. Free flaps have improved in versatility and variability in recent years, and are now among the techniques used for burn reconstruction. Methods: Thirty-six free flaps for 32 patients with cervicofacial burns were reviewed retrospectively over a 17-year period (1989 to 2005) to determine indications, methods, and outcomes. Results: The mean patient age was 31 years. Thirteen flaps were transferred to the neck and 23 to the face. The main indication was contractures or hypertrophic scarring followed by exposed bone or cartilage. The majority of flaps were transferred for secondary reconstruction. The free flaps most frequently used were the anterolateral thigh (31 percent), scapular/parascapular (31 percent), and radial forearm (17 percent). Fourteen were prefabricated, one was prelaminated, and 15 were tissue-expanded. A total of 34 flaps (94 percent) were successful. There were no deaths, two donor-site complications, a 17 percent tip necrosis rate, and a 6 percent flap infection rate. The median hospital stay was 6 days after free flap transfer. Patients were followed for at least 1 year, and 64 percent of flaps needed further debulking or sculpting. Conclusions: Free tissue transfer is a valuable tool in head and neck burn reconstruction. It can be used safely and effectively with minimal morbidity in selected patients.